Housing needs of grandparent caregivers: grandparent,youth, and professional perspectives

ABSTRACT

This qualitative study examined the housing needs of grandparent caregivers and the youth in their care in New York State. Nine focus groups were conducted separately with grandparent caregivers (n = 46) and youth (n = 34), and interviews were conducted with key informants (n = 17) knowledgeable about housing and issues. Housing needs of greatest priority, contextual differences, and potential barriers to securing housing and social services were identified. Key themes indicated that housing challenges stem from four problem domains: the experience of poverty, which creates affordability challenges that trap grandparent caregivers and their grandchildren in unsuitable homes and unsafe neighborhoods; physical challenges of aging grandparents, which require specific housing accommodations; changes in family composition when taking in grandchildren, which necessitate moving out of prior accommodations or changing housing plans due to regulatory issues; and obstacles to obtaining needed benefits, including a lack of information, burdensome application processes, ineligibility, and a shortage of resources. These issues are discussed with implications for policy and practice.     

The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care

The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components—care coordination, case management, and patient engagement—which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment’s emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.     

Transnational Caregiving for My Father: An Opportunity and a Blessing

Transnational caregiving can be daunting, yet it often brings out the strengths of the caregiver that he or she may not have been aware of. Thus, it is a wonderful opportunity to know oneself and use those strengths to become better in other areas of life. Transnational caregiving is also a blessing, in that one can still continue to provide care for a loved one by surmounting the barriers of geographical distance. To transform what often is a challenging situation into a blessing, a fresh eye is needed to seek different ways of fulfilling the needs of the loved one by focusing on one thing: How can the caregiver, in his or her individual capacity, make a difference in the quality of life of the family member? This article, while relating personal experience in caring for a parent, traverses these issues.     

A Time and Place: The Role of Social Workers in Improving End-of-Life Care

Americans are living longer, but dying after a prolonged period of management of multiple chronic illnesses and functional disabilities. Despite waves of public and professional activity targeted toward improving care for the dying and supporting the families, gaps in care and challenges in end-of-life care persist. Contentious issues such as the so-called “death panels” or physician payment for discussion of advance directives and care wishes at the end of life; aid in dying; and regarding individuals who actively choose death (case of Brittney Maynard) are continually debated in the public media. Progress toward improvement in the experience of dying remains incremental and change has been slow. With the release of a second Institute of Medicine (2014 Institute of Medicine (IOM). (2014). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: National Academy Press. [Google Scholar]) report devoted to what it means to die in America in the 21st century, momentum and opportunity for change may increase. If this is to happen, social workers will need to deliver the range of biopsychosocial care that patients and families so desperately need. However, holistic care of the individual will only improve, if the nation also addresses ongoing systemic problems in financing, policy, and service delivery in end-of-life care.     

Re B‐S: a glass half full? An exploration of the implications of the Re B‐S judgment on practice in the family courts

The family courts in England and Wales are being significantly reformed in line with the coalition government's aim to speed up the process and increase the numbers of children being adopted from care. In September 2013, the Court of Appeal handed down a judgment, Re B‐S (Children) [2013] EWCA Civ 1146, that has wide‐ranging implications for professional practice and decision making in care proceedings. The judgment challenges the policy direction and provides guidance about what is required before courts can make orders separating children from their birth families, particularly in cases of non‐consensual adoption. In this paper, we outline the changes occurring in the family justice system, some key elements of Re B‐S, and examine the challenges for implementing practice consistent with the requirements of Re B‐S. It is argued that the standards set by Re B‐S are unlikely to be fully implemented without much further attention to the complexities posed by the policy and practice context of social work with children and their families involved in care proceedings.     

Family Caregiving and the Site of Care: Four Narratives About End-of-Life Care for Individuals with Dementia

Little is known about end-of-life care for individuals with Alzheimer’s disease and other dementias. Four case studies are presented, using data collected by qualitative interviews conducted with family caregivers who were closely involved with end-of-life care for relatives with dementia. The case studies are formatted in two pairs, with one reflecting two deaths occurring at home and the other pair representing two deaths in the nursing home. The cases reveal a range of end-of-life experiences, suggesting that there is not just one “good” path. The extent of care needed, the responsiveness of the individual, the health of the caregiver(s), and the residence and support situations, can all intersect in a variety of ways that make no one scenario the answer for all. Although most people say they would prefer to die at home, in some situations the nursing home can be a satisfactory choice, particularly if hospice is involved. These narrative case studies give the reader insight into the variety of the end-of-life experiences and suggest the environment should be considered as part of the care provision.     

我国公共医疗卫生服务定价机理与价值补偿研究——基于供需双方价值补偿的视角

我国公共医疗卫生服务供给遵循市场价格机制与契约治理规则,整个供给流程存在产权委托代理链和价值补偿链。资金流包括卫生费用筹集和医疗服务消费价值补偿两个方向,需方医疗卫生总费用由政府公利、社会共济和个人付费的多元分摊机制承担;医疗机构等供方通过财政补助和医疗服务事业收入获得成本补偿和合理收益。在医疗保险等第三方偿付机构的介入下,多方利益主体之间的博弈带来“公域”部门道德风险和“私域”部门市场失灵问题,其激励源于行政分权和财政分权改革。规范各参与主体的效用目标,加强监管,整合城乡医疗保障制度,对提高医疗服务利用率、增进社会公平有积极意义。     

Rubella Susceptibility and Immunization in a University Population: Experience,Strategy, and Policy

Abstract

Despite the availability of a safe and effective vaccine, rubella continues to occur in the United States. In recent years 70% of all cases have occurred in college aged individuals. Since 1978 the University of Rochester has required all entering students to have either rubella immunization or rubella serology. Compliance with this requirement has been excellent and has resulted in an increase in the rubella immunization rate from 52% to 71 %. Of those obtaining serology, the overall susceptibility rate (HI titer < 1:16) was 18%. Less than half of susceptible women accepted immunization, and few susceptible men sought immunization. College entry is a logical time to define an individual's rubella status.     

Effects of Aerobic Training on Primary Dysmenorrhea Symptomatology in College Females

Abstract

“Single-Dose Therapy for Cystitis in Women: A Comparison of Trimethoprim-Sulfamethoxazole, Amoxicillin, and Cyclacillin,” Thomas M. Hooton et al. We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of the 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted antibody-coated bacteria test results from negative to positive after therapy. We conclude that single-dose treatment of cystitis in unselected women with cyclacillin and amoxicillin may result in low cure rates and that progression to acute pyelonephritis may occur following ineffective single-dose therapy. (Journal of the American Medical Association 1985;253:387-390.)